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<br />sss <br /> ANN~iiAi, FF.F, and REPORT RF.t7i1F,fiT <br />PERMITTEE NAME: `William E. Burnett <br />RECEIV <br />PERMIT NO.: ~ 1977-293 ED <br />OPERATION NAME: Monogram-Jo Dandy NOV 3 0 <br />ANNNERSARY DATE: November 27, 2005 <br /> ~ Uivisian at Minerals and CeoloBY <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: Montrose <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />---aperatorsha3l submitthe annual-£ee; a-report-and-map-showing-the-eztcaTt-af-current-disturbances-to-affeCed---- <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach err revised written anmral rennrt and annual rennrt maT to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: William E. Burnett <br />Permittee Name: William E. Burnett <br />Address: 5002 Syndt Rd. <br />Evergreen, CO 80439 <br />Phone Number: (303) 697-4043 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />~Jf .~ ~~.~~`5~ci,,..~ <br />Signature of Corporate Officer, Owner, or Designee <br />Dale <br />M:~PERMITMASTEADOCUMENTS/M-AF-02.DOC <br />